Clinicians in 25 countries prefer to use lower levels of oxygen to resuscitate preterm infants at birth

Abstract

Clinicians currently favour lower SpO2 targets for preterm resuscitation, despite acknowledging the lack of evidence for benefit or harm, and 65% would join a clinical trial.

A review of international clinical practice guidelines for the use of oxygen in the delivery room resuscitation of preterm infants

“…Our study shows that CPGs for using oxygen to resuscitate preterm infants vary considerably around the world. For example, most CPGs would recommend using FiO 2 < 0.3 for preterm resuscitation, and this is mirrored by clinical opinion, where >80% would initiate resuscitation of preterm infants with FiO 2 < 0.4 . However, international expert committees acknowledge the lack of good quality evidence behind their recommendations , particularly in regard to longer term outcomes.…”

“…For example, our survey found that only 42% of tertiary hospitals in 2008 and 20% of nontertiary units in 2011 in Australia and New Zealand had access to oxygen blending equipment. In 2015, >80% of neonatal clinicians would use FiO 2 0.21–0.4 to initiate preterm infant resuscitation, most (78%) would adjust FiO 2 to target SpO 2 that were at or below the 50th percentile for healthy preterm infants and only four would resuscitate with FiO 2 1.0 because they had no access to oxygen blending equipment .…”

“…A recent survey of 630 clinicians from 25 countries showed that >80% of respondents would initiate preterm infant resuscitation with FiO 2 <0.4 and that most would not use FiO 2 >0.6 because of concerns of oxidative injury. Most clinicians would then also adjust FiO 2 to meet lower (<50th percentile) SpO 2 targets that were derived from spontaneously breathing, healthy term or preterm infants .…”

Impact of Changing Clinical Practices on Early Blood Gas Analyses in Very Preterm Infants and Their Associated Inpatient Outcomes

“…The situation is a little less clear for preterm infants, even though the potential for harm is greater: cautious use has been recommended in anticipation of future randomized controlled trials. Many centers like ours initiate resuscitation with 21–30% oxygen to avoid hyperoxia ( 29 ). Using the published SpO 2 nomogram of newborn infants in the DR, inspired oxygen concentration is currently titrated to target the oxygen saturation ranges during neonatal resuscitation and stabilization ( 16 ).…”

How to decrease bronchopulmonary dysplasia in your neonatal intensive care unit today and “tomorrow”

“…However, given that the overall estimates of effect have a wide range of confidence intervals, additional data are required to be definitive. Currently, we would recommend initiating resuscitation in the DR with a default setting of FiO 2 of 0.3–0.4 24 and titrating by 5–10% upwards or downwards. Using a T-piece resuscitator to provide continuous positive airway pressure (CPAP) or non-invasive intermittent positive pressure ventilation (NIPPV) is recommended.…”